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Family Practice Vol. 18, No. 6, 569-573
© Oxford University Press 2001

Original Paper

Variation in diagnosis and management of common foot problems by GPs

Kees Gorter, Saskia de Poel, Ruut de Melker and Marijke Kuyvenhoven

Julius Center for General Practice and Patient oriented Research, University Medical Center (UMC), PO Box 85060, 3508 AB Utrecht, The Netherlands.

Background. There are indications that the diagnosis and management of common foot problems vary widely in general practice.

Objectives. Our aim was to explore the variation of GPs' diagnosis and management of common foot problems and the possible correlation between GPs' characteristics and their competence to diagnose correctly.

Methods. In a cross-sectional design, 90 GPs in The Netherlands were invited to complete a questionnaire regarding seven vignettes with common foot problems (hallux valgus, hallux rigidus, fasciitis plantaris, tarsal tunnel syndrome, metatarsalgia, corns and calluses, and rheumatoid arthritis), combined with questions covering diagnoses, management options and some GP characteristics.

Results. A total of 72 GPs responded (80%). They most often diagnosed hallux valgus (79%) and rheumatoid arthritis (86%) correctly, and most often hallux rigidus (37%) and tarsal tunnel syndrome (74%) incorrectly. GP characteristics did not correlate with their competence in diagnosing. The most frequently suggested management was referral to a podiatrist. The referral rate to medical specialists was low, except in the case of rheumatoid arthritis (79%).

Conclusions. More than half of the GPs were competent in diagnosing vignettes of common foot problems. This diagnostic competence showed great variation and was not associated independently with GP characteristics. Educational programmes are recommended. Management showed less variation and often included referral to podiatrists. Further research into the effectiveness of specific treatments for different foot problems is recommended.

Keywords. Diagnosis, foot, general practice, management, vignette methodology.


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J. W. Peabody, J. Luck, P. Glassman, S. Jain, J. Hansen, M. Spell, and M. Lee
Measuring the Quality of Physician Practice by Using Clinical Vignettes: A Prospective Validation Study
Ann Intern Med, November 16, 2004; 141(10): 771 - 780.
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